M A S T E R B A T C H - Gala Industries
M A S T E R B A T C H - Gala Industries
M A S T E R B A T C H - Gala Industries
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REGISTRATION FORM<br />
Masterbatch 2011, 7-9 June<br />
The Imperial Riding School Vienna, a Renaissance Hotel, Vienna, Austria,<br />
Ungargasse 60, Vienna 1030, Austria<br />
Company:_____________________________________________________<br />
Address: _______________________________________________________<br />
____________________________________________________________ __<br />
______________________________________________________________<br />
Country:_ ______________________________________________________<br />
Tel:_________________________ Fax:_ ______________________________<br />
e-mail address:_ _________________________________________________<br />
VAT No.:__________________________________________________<br />
(must be completed by all EU Companies)<br />
Company activity: _ ______________________________________________<br />
Invoice address (if different from above ):_____________________________<br />
________________________________________________________<br />
________________________________________________________<br />
DELEGATE DETAILS / TABLE TOP DELEGATE:<br />
(If more than one delegate please photocopy form)<br />
Title:________ First name:_________________________________________<br />
Surname:_______________________________________________________<br />
Position:_______________________________________________________<br />
Special dietary requirements: _ _________________________________<br />
PAYMENT DETAILS<br />
All payments to be made in Euros<br />
Early bird discount (990 if you register before the 15th April 2011<br />
Delegate fee @ (990 ___________<br />
(until 15th April 2011)<br />
Delegate fee thereafter @ (1100 ___________<br />
Exhibition package @ (2750 ____________<br />
(includes one free delegate place)<br />
Conference dinner @ (100 ___________<br />
(per person)<br />
Total: ___________<br />
Method of payment<br />
On receipt of this registration form your credit card will be debited.<br />
You will be sent an invoice in 5 working days.<br />
q<br />
q<br />
Bank Transfer quoting : ‘Applied Market Information Ltd.<br />
- Masterbatch 2011’ to: Commerzbank,<br />
Filiale Düsseldorf, Breite Straße 25, 40213 Düsseldorf, Germany<br />
Account number: 1024710 Bank No. 300 400 00<br />
IBAN: DE93 3004 0000 0102 4710 00 SWIFT: COBADEFFXXX<br />
Visa / Mastercard / Eurocard / JCB<br />
(Please note all card payments will be processed in £ Sterling)<br />
- - -<br />
Name of cardholder: _ ____________________________________________<br />
Expiry date:______________________ 3- digit security code:_____________<br />
Cardholder’s signature:___________________________________________<br />
Signature: ________________________ Date:_________________________<br />
Fax back to +44 (0)117 311 1534